Pulmonary Embolism With Syncope Treated With Inari FlowTriever®.

Pulmonary embolism (PE) is a devastating disease that can range in severity from asymptomatic to fatal. The severity and the intervention required depend on the degree of hemodynamic instability and evidence of right heart strain demonstrated on diagnostic testing. Interventions include solely anticoagulation, systemic thrombolysis, catheter-directed therapies, or surgical embolectomy depending on the severity, patient's clinical picture, and clinician choice. Currently, there is a lack of evidence regarding which treatment is most suitable for submassive PE. This report demonstrates the benefits of aspiration thrombectomy, a catheter-directed therapy, utilizing the 24Fr Triever Aspiration Catheter (FlowTriever® system;Inari Medical, Irvine, California, United States) in a 57-year-old male patient with submassive PE. The FlowTriever retrieval/aspiration system is a single-use mechanical thrombectomy device indicated for use in the peripheral vasculature and pulmonary arteries. The patient presented with syncope and concern for head trauma ultimately requiring suction embolectomy utilizing the Inari FlowTriever system. We conclude that submassive PE can be effectively treated with aspiration thrombectomy in addition to long-term anticoagulation with excellent clinical outcomes.

Syphilis Among U.S.-Bound Refugees, 2015 - 2018.

We assessed syphilis screening data from overseas medical examinations among U.S.-bound refugees to characterize seropositive syphilis cases and treatment from January 1, 2015, to December 31, 2018. During this time period, all refugees 15 years and older were required to undergo syphilis screening prior to resettlement to the United States. Of the 160,381 refugee arrivals who had a syphilis screening performed, 697 (434 per 100,000) were diagnosed with any stage (infectious or non-infectious) of syphilis. Among the 697 persons with seropositive syphilis, a majority (63%) were from the Africa region and were male (58%), and 53 (7.6%) were diagnosed with an infectious stage of syphilis. All infectious cases were treated prior to resettlement. This information suggests a comparable risk of infection among U.S.-bound refugees compared to a report of syphilis among U.S.-bound refugees from 2009 to 2013, indicating low rates in this population for at least a decade.

A Practical Significance Bias in Laypeople's Evaluation of Scientific Findings.

People often rely on scientific findings to help them make decisions-however, failing to report effect magnitudes might lead to a potential bias in assuming findings are practically significant. Across two online studies (Prolific; N = 800), we measured U.S. adults' endorsements of expensive interventions described in media reports that led to effects that were small, large, or of unreported magnitude between groups. Participants who viewed interventions with unreported effect magnitudes were more likely to endorse interventions compared with those who viewed interventions with small effects and were just as likely to endorse interventions as those who viewed interventions with large effects, suggesting a practical significance bias. When effect magnitudes were reported, participants on average adjusted their evaluations accordingly. However, some individuals, such as those with low numeracy skills, were more likely than others to act on small effects, even when explicitly prompted to first consider the meaningfulness of the effect.

The Reasoning through Evidence versus Advice (EvA) Scale: Scale Development and Validation.

Our well-being can improve when people heed evidence rather than simply follow familiar or charismatic advisors who neglect evidence. We developed the Reasoning through Evidence versus Advice (EvA) scale to measure individual differences in reasoning through evidence like science and statistics versus following advisors such as politicians and celebrities. No existing scales directly measure these tendencies; moreover, it was theoretically unknown whether they reflect a single dimension (from evidence- to advice-based) or distinct tendencies to value or distrust each. Our scale validation process included qualitative interviews and four studies that involved 1583 respondents (753 college graduates, 830 non-college graduates) in which we conducted exploratory and confirmatory factor analyses and tests of convergent validity, discriminant validity, and measurement invariance by gender and education. This process yielded a 16-item EvA scale with four dimensions: Pro-evidence, Anti-evidence, Pro-advice, and Anti-advice. In assessing criterion validity, these tendencies identified individual differences in important, real-world attitudes and behaviors, including susceptibility to health misinformation, adherence to CDC guidelines on social distancing, confidence in the COVID vaccine, science curiosity, and religiosity. The EvA scale extends our understanding of individual differences in reasoning tendencies that shape critical attitudes, decisions, and behaviors and can help promote informed decisions.

A d factor? Understanding trait distractibility and its relationships with ADHD symptomatology and hyperfocus.

People differ substantially in their vulnerability to distraction. Yet, many types of distractions exist, from external stimulation to internal thoughts. How should we characterize individual differences in their distractibility? Two samples of adult participants (total N = 1220) completed a large battery of questionnaires assessing different facets of real-world distractibility. Latent modeling revealed that these measures could be explained by three correlated-yet-distinct factors: external distraction, unwanted intrusive thoughts, and mind-wandering. Importantly, about 80% of the total variance in these three factors could be explained by a single higher-order factor (d) that could be construed in terms of a person's general distractibility, and this general distractibility model was replicated across the two samples. We then applied the general distractibility model to understand the nature of ADHD symptomatology and hyperfocus (an intense state of long-lasting and highly focused attention). d was substantially associated with self-reported ADHD symptoms. Interestingly, d was also positively associated with hyperfocus, suggesting that hyperfocus may, to some degree, reflect attention problems. These results also show marked consistencies across the two samples. Overall, the study provides an important step toward a comprehensive understanding of individual differences in distractibility and related constructs.

The association between different sources of distraction and symptoms of attention deficit hyperactivity disorder.

Introduction: Adults with Attention-Deficit/Hyperactivity Disorder (ADHD) are generally distractible. Yet, the precise relationship between ADHD and distractibility remains under-specified in two respects. First, different sources of distraction, such as background noise or mind wandering, may not be equally associated with ADHD. Second, ADHD itself comprises a variety of symptoms that show considerable heterogeneity and it is unclear which ADHD symptoms are associated with which type of distraction. Methods: The current study addresses these questions using one clinically evaluated sample (N = 69) and two large non-clinically evaluated samples (N = 569, N = 651). In all samples, participants completed questionnaires about their susceptibility to external distraction, unwanted intrusive thoughts, spontaneous mind-wandering and ADHD symptomatology. Results: Traditional regression and novel network analyses revealed an overwhelming contribution of spontaneous mind-wandering in explaining ADHD symptoms, although external distraction and unwanted intrusive thoughts were also associated with a small number of ADHD symptoms. Discussion: Findings support a growing body of literature linking spontaneous mind-wandering and ADHD, and they highlight the heterogeneity in the association between ADHD symptoms and different sources of distraction.

How essentialist reasoning about language acquisition relates to educational myths and policy endorsements.

How people conceptualize learning is related to real-world educational consequences across many domains of education. Despite its centrality to the educational system, we know little about how the public reasons about language acquisition, and the potential consequences for their thinking about real-world issues (e.g., policy endorsements). The current studies examined people's essentialist beliefs about language acquisition (e.g., that language is innate and biologically based), then investigated how individual differences in these beliefs related to the endorsement of educational myths and policies. We probed several dimensions of essentialist beliefs, including that language acquisition is innate, genetically based, and wired in the brain. In two studies, we tested specific hypotheses regarding the extent to which people use essentialist thinking when reasoning about: learning a specific language (e.g., Korean), learning a first language more generally, and learning two or more languages. Across studies, participants were more likely to essentialize the ability to learn multiple languages than one's first language, and more likely to essentialize the learning of multiple languages and one's first language than the learning of a particular language. We also found substantial individual differences in the degree to which participants essentialized language acquisition. In both studies, these individual differences correlated with an endorsement of language-related educational neuromyths (Study 1 and pre-registered Study 2), and rejection of educational policies that promote multilingual education (Study 2). Together, these studies reveal the complexity of how people reason about language acquisition and its corresponding educational consequences.

The power of rotation schedules on the career selection decisions of medical students.

Choosing a career pathway in medicine is a high stakes decision for both medical students and the field of medicine as a whole. While past research has examined how characteristics of the medical student or specialties influence this decision, we introduce temporal elements as novel variables influencing career selection decisions in medicine. Specifically, we investigate how timing and duration of residency options, based on a rotation schedule that medical students have limited control over, influence their career selection decisions. An archival study investigating 5 years of medical student rotation schedules (N = 115) reveals that clinical rotation options appearing earlier and more often in the schedule were more likely to be selected. Moreover, timing and duration of exposure interacted such that residency options appearing later in the schedules were more likely to be selected if they also appeared more often. Conditional logistic regressions using student fixed-effects to control for idiosyncratic medical student differences (i.e., gender, & debt, etc.), and residency fixed-effects to control for idiosyncratic residency differences (income, and lifestyle, etc.), revealed the rotation schedule had a significant impact on residency selection decisions even when controlling for factors typically influencing this decision. Medical students' career decisions are influenced by when and how long different choice options appear in their rotation schedule, especially when they have limited influence over this schedule. The results have implications for healthcare policy by highlighting a tool for adjusting physician workforce composition by broadening exposure to a greater array of career options.

The Ability of Near-Infrared Spectroscopy to Identify Vulnerable Patients and Plaques: A Systematic Review and Meta-Analysis.

Previous studies have analyzed the efficacy of near-infrared spectroscopy-derived lipid core burden index (LCBI) in quantifying and identifying high-risk plaques and patients at increased risk of future major adverse cardiac outcomes/major adverse cardiovascular and cerebrovascular events. A maxLCBI4mm of 400 or greater seems to be an effective threshold for classifying at-risk plaques. This meta-analysis provides a more precise odds ratio with a narrow standard deviation that can be used to guide future studies.

The Impact of Preoperative Breast Volume on Development of Mastectomy Skin Flap Necrosis in Immediate Breast Reconstruction.

BACKGROUND: Mastectomy skin flap necrosis (MSFN) can significantly impact outcome after immediate breast reconstruction. Several techniques exist to predict MSFN, but these may require additional testing and information, and they are often not available before surgery. We aim to identify whether breast volume, as calculated from preoperative mammography, can be used as a preoperative predictor of MSFN. METHODS: A retrospective chart review from 2010 to 2020 resulted in 378 patients who underwent immediate implant-based breast reconstruction. Complete imaging data were available for 278 patients and 441 reconstructed breasts. Demographic, perioperative, and outcomes data were collected. Measurements from preoperative diagnostic mammograms were used to calculate breast volume. Univariate and multivariate analyses were used to evaluate the association of variables available preoperatively, including breast volume from mammogram and MSFN. Secondary analyses were performed for need for reoperation and loss of reconstruction. RESULTS: On univariate analysis of MSFN development, demographic variables found to be significantly associated with MSFN included body mass index (P = 0.04), diabetes (P = 0.03), and breast volume calculated from routine mammography (P ≤ 0.0001). Average preoperative breast volume via mammography without and with MSFN was 970.6 mL (95% confidence interval [CI], 908.9-1032.3) and 1298.3 mL (95% CI, 1140.0-1456.5) (P < 0.0001), respectively. Statistically significant intraoperative variables for MSFN development included prolonged operative time (P = 0.005), greater initial tissue expander fill volumes (P ≤ 0.001), and prepectoral implant location (P = 0.02). Higher initial tissue expander fill volumes in implant-based reconstructions were associated with increased rates of MSFN, 264.1 mL (95% CI, 247.2-281.0) without MSFN and 349.9 mL (95% CI, 302.0-397.8) in the group with MSFN, respectively (P < 0.001). On multivariate analysis, preoperative imaging volume (P = 0.02) was found to be significant, whereas body mass index and diabetes lost significance (P = 0.40) in association with MSFN. CONCLUSIONS: The results of this study establish an association between larger breast volume on preoperative imaging and development of MSFN. This may be useful as a tool for more appropriate patient selection and guidance in the setting of immediate breast reconstruction.

Icon arrays reduce concern over COVID-19 vaccine side effects: a randomized control study.

On April 13, 2021, the CDC announced that the administration of Johnson and Johnson's COVID-19 vaccine would be paused due to a rare blood clotting side effect in ~ 0.0001% of people given the vaccine. Most people who are hesitant to get a COVID-19 vaccine list potential side effects as their main concern (PEW, 2021); thus, it is likely that this announcement increased vaccine hesitancy among the American public. Two days after the CDC's announcement, we administered a survey to a group of 2,046 Americans to assess their changes in attitudes toward COVID-19 vaccines. The aim of this study was to investigate whether viewing icon arrays of side effect risk would prevent increases in COVID-19 vaccine hesitancy due to the announcement. We found that using icon arrays to illustrate the small chance of experiencing the blood clotting side effect significantly prevented increases in aversion toward the Johnson and Johnson vaccine as well as all other COVID-19 vaccines.

How well do ordinary Americans forecast the growth of COVID-19?

Across three experiments (N = 1565), we investigated how forecasts about the spread of COVID 19 are impacted by data trends, and whether patterns of misestimation predict adherence to social-distancing guidelines. We also investigated how mode of data presentation influences forecasting of future cases by showing participants data on the number of COVID-19 cases from a 5-week period in either graphical, tabular, or text-only form. We consistently found that people shown tables produced more accurate forecasts compared to people shown line-graphs of the same data; yet people shown line-graphs were more confident in their estimates. These findings suggest that graphs engender false-confidence in the accuracy of forecasts, that people's forecasts of future cases have important implications for their attitudes concerning social distancing, and that tables may be better than graphs for informing the public about the trajectory of COVID-19.

Wagner's Classification as a Tool for Treating Diabetic Foot Ulcers: Our Observations at a Suburban Teaching Hospital.

Objectives The study aims to scale patients with diabetic foot ulcers according to Wagner's classification, measure the various risk factors, study various outcomes and improve the treatment measures. Methodology The article presents materials on a prospective observational study of 50 diabetic foot patients with different presentations who underwent stage-specific intervention. Results Poor glycemic control, lifestyle factors, and smoking showed increased risks for foot ulcer complications. Diabetic neuropathy and vasculopathy have been significant outcome predictors. As a result, advanced Wagner's grades showed increased amputation risks and multimodal management. Conclusions Stratification of diabetic foot patients and appropriate management based on their Wagner's grade helps reduce amputation rates and mortality. In addition, multimodal management and exceptional attention to diabetes and lifestyle control improve long-term outcomes.

The effect of mode of presentation on Tower of Hanoi problem solving.

The Tower of Hanoi (TOH) is a classic problem that can be solved via multiple strategies. This study used TOH to examine how mode of presentation of a problem influences strategy use and transfer. Undergraduate students (Experiment 1) or Prolific workers (Experiment 2) completed two TOH problems of varying difficulty (4-disk/5-disk). They were randomly assigned to different conditions in which problems were either high in internal representation (mental) or high in external representation (computer). Participants were better able to complete problems successfully when external representations were available but completed problems in fewer moves when relying on internal representations. In addition, participants spent more time between moves when solving problems mentally, suggesting that external representations encourage speed while internal representations promote accuracy when solving recursion problems. Lastly, both experiments provide evidence that first solving a problem mentally encouraged participants to use strategies similar to goal recursion on a second problem.

Graphs do not lead people to infer causation from correlation.

Media articles often communicate the latest scientific findings, and readers must evaluate the evidence and consider its potential implications. Prior work has found that the inclusion of graphs makes messages about scientific data more persuasive (Tal & Wansink, 2016). One explanation for this finding is that such visualizations evoke the notion of "science"; however, results are mixed. In the current investigation we extend this work by examining whether graphs lead people to erroneously infer causation from correlational data. In two experiments we gave participants realistic online news articles in which they were asked to evaluate the research and apply the work's findings to a real-life hypothetical scenario. Participants were assigned to read the text of the article alone or with an accompanying line or bar graph. We found no evidence that the presence of graphs affected participants' evaluations of correlational data as causal. Given that these findings were unexpected, we attempted to directly replicate a well-cited article making the claim that graphs are persuasive (Tal & Wansink, 2016), but we were unsuccessful. Overall, our results suggest that the mere presence of graphs does not necessarily increase the likelihood that one infers incorrect causal claims. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Causal theory error in college students' understanding of science studies.

When reasoning about science studies, people often make causal theory errors by inferring or accepting a causal claim based on correlational evidence. While humans naturally think in terms of causal relationships, reasoning about science findings requires understanding how evidence supports-or fails to support-a causal claim. This study investigated college students' thinking about causal claims presented in brief media reports describing behavioral science findings. How do science students reason about causal claims from correlational evidence? And can their reasoning be improved through instruction clarifying the nature of causal theory error? We examined these questions through a series of written reasoning exercises given to advanced college students over three weeks within a psychology methods course. In a pretest session, students critiqued study quality and support for a causal claim from a brief media report  suggesting an association between two variables. Then, they created diagrams depicting possible alternative causal theories. At the beginning of the second session, an instructional intervention introduced students to an extended example of a causal theory error through guided questions about possible alternative causes. Then, they completed the same two tasks with new science reports immediately and again 1 week later. The results show students' reasoning included fewer causal theory errors after the intervention, and this improvement was maintained a week later. Our findings suggest that interventions aimed at addressing reasoning about causal claims in correlational studies are needed even for advanced science students, and that training on considering alternative causal theories may be successful in reducing casual theory error.

Predicting future left anterior descending artery events from non-culprit lesions: insights from the Lipid-Rich Plaque study.

AIMS: The left anterior descending (LAD) artery is the most frequently affected site by coronary artery disease. The prospective Lipid Rich Plaque (LRP) study, which enrolled patients undergoing imaging of non-culprits followed over 2 years, reported the successful identification of coronary segments at risk of future events based on near-infrared spectroscopy-intravascular ultrasound (NIRS-IVUS) lipid signals. We aimed to characterize the plaque events involving the LAD vs. non-LAD segments. METHODS AND RESULTS: LRP enrolled 1563 patients from 2014 to 2016. All adjudicated plaque events defined by the composite of cardiac death, cardiac arrest, non-fatal myocardial infarction, acute coronary syndrome, revascularization by coronary bypass or percutaneous coronary intervention, and rehospitalization for angina with >20% stenosis progression and reported as non-culprit lesion-related major adverse cardiac events (NC-MACE) were classified by NIRS-IVUS maxLCBI4 mm (maximum 4-mm Lipid Core Burden Index) ≤400 or >400 and association with high-risk-plaque characteristics, plaque burden ≥70%, and minimum lumen area (MLA) ≤4 mm2. Fifty-seven events were recorded with more lipid-rich plaques in the LAD vs. left circumflex and right coronary artery; 12.5% vs. 10.4% vs. 11.3%, P = 0.097. Unequivocally, a maxLCBI4 mm >400 in the LAD was more predictive of NC-MACE [hazard ratio (HR) 4.32, 95% confidence interval (CI) (1.93-9.69); P = 0.0004] vs. [HR 2.56, 95% CI (1.06-6.17); P = 0.0354] in non-LAD segments. MLA ≤4 mm2 within the maxLCBI4 mm was significantly higher in the LAD (34.1% vs. 25.9% vs. 13.7%, P < 0.001). CONCLUSION: Non-culprit lipid-rich segments in the LAD were more frequently associated with plaque-level events. LAD NIRS-IVUS screening may help identify patients requiring intensive surveillance and medical treatment.